Life Science ourna, 3 (2),2006, Panyzping, et a, Medica Waste Management Practices in Thaiand f.,, Medica Waste Management Practices in Thaiand / Kinpratoom Panyaping, Benedict Okwumabua2. Department of Environmenta Engineering, Raamagaa University of Technoogy Lanna (RMTUL), Northern Campus, Chiang Mai 50300, Thaiand 2. Michigan Department of Environmenta Quaity, Waste and Hazardous Materias Division, Warren, Michigan 48092, USA Abstract: nappropriate medica waste management practices (WMPs) can cause hazards and risks that affect not ony the generators and operators but aso the genera community. An investigation of WMPs in hospitas in Thaiand has shown simiar and different patterns of medica WMPs consisting of infectious waste, soid waste and hazardous waste, incuding wastewater practices. The quantity of infectious waste generated from different size of hospitas in Chiang Mai is at a rate of 0.7 kg/dbed to 0.97 kg/dbed. Most hca'ipitashave an incinerator where medica waste is burned. The ash from the incinerator shoud be propery disposed in a andfi. Soid waste in hospitas is sent to a municipa andfi. n some hospita, there is a thriving recycing program. Some hazardous waste is either burned or sent to a private secured andfi. Others are coected in hospitas and stored for disposa. However, the assigned government agencies and a manua for heping them sove waste probems are needed. A hospitas have wastewater treatment pants (WWTP). Some WWTP need advice for coping effectivey with the WWTP probems. n order to provide more effective WMPs in hospitas, a standard operating procedure (SOP) and reguations for segregation of infectious waste, soid and hazardous wastes must be deveoped. The SOP shoud outine the method for handing hospita wastes, how to coect, segregate, treat and dispose of these wastes. Furthermore, the agency responsibe for reguating incinerators and WWTPs in the hospitas shoud reguary visit and inspect these faciities for improving their efficiency and soving probems when they occur. [Life Science ourna. 2006; 3 (2): 88-93] (SSN: 097-835)..] Ị. C. Keywords: waste management practices; medica waste; reguations; standard operating procedure Abbreviations: SOP: standard operating procedure; WMPs: waste management practices; WWTP: wastewater treatment pants. ntroduction According to the Word Heath Organization (WHO), the waste produced by heath care faciities carries a higher potentia for hazards and risks from infection and inury than any other kind of waste[]. Medica waste or hospita waste consists of infectious, radioactive and toxic substances, as we as unsafe materia from activities in cinics and aboratories in hospitas. t incudes human bood and bood products wastes, tissues, anima wastes, microbioogy aboratory wastes, radioactive and chemica wastes, pharmaceutica, sharp wastes in addition to genera waste ike paper, food and pastics[2]. Based upon the WHO 994 report of hospita waste in America, Netherands, and France, about 85 % of the hospita wastes are actuay nonhazardous waste, 0 % are infectious waste and 5% are non-infectious waste but hazardous wastes. Athough infectious and hazardous wastes from hospi- tas occur in sma quantity of waste, there is a high potentia of serious threat to spread out various diseases and hazardous materias from these wastes due to improper disposa of dumping and burning. The poor management of medica waste poses risks to pubic heath and the environment, especiay, in terms of the transmission of disease by viruses and microorganisms, contamination of underground water tabes by untreated medica waste in andfis, as we as contamination of ambient air by uncontroed burning. The probem of medica waste disposa in hospitas has become an issue of increasing concern, prompting hospita administration to seek new ways of safe and cost effective management of the waste, and keeping their personne infotnedof the advances in this fied. n Thaiand, the estimated quantity of infectious waste by Poution Contro Department (PCD) in 2000 was reported to be a tota of 3,250 tons or 36. ton/day[3]. These are generated from both government and private hospitas. Of 22 tons of infectious wastes are. 88.,
. t Life Science ourna, 3 (2),2006, Panyaping, et a, Medica Waste ManagemEnt Practices in Thaiand (. [ t r (., -, generated in the regiona part whie about 24. tons of these wastes are generated in Bangkok and the nearby area.. Waste management program The concept of waste management program has been introduced to many activities, namey, industries, business and commercia, communities, houses, and hospitas. t incudes waste minimization, reduce/reuse and recyce, incinerator and andfi. The adoption and promotion of this program are sti very imited in the hospitas because accrediting system is not functioning due to some barriers, such as government reguations on medica waste management, ack of support from hospita administrators, and poor environmenta awareness. Therefore, the commitment of hospita directors to better management is the most important criterion in promoting the waste management program to hospitas. Without support from the hospita directors, good government reguations and better environmenta awareness of the staff, introduction of waste management program wi be difficut..2 Waste management procedures t consists of waste coection and segregation, storage, transportation, treatment and disposa[4. Segregation of waste is the most important step in the process of waste management. t aows management of sma quantities of waste thereby reducing the risks as we as cost of handing and disposa of a arge minged waste. Segregated waste need to be stored in identifiabe containers, and must separate infectious waste from hazardous waste. The genera waste or soid waste and non-hazardous waste transportation shoud be kept infectious waste and hazardous waste. The transportation containers shoud be propery encosed. The driver must be trained to foow estabished procedures in case of traffic accidenta spiage[5..3 Medica waste treatment technoogies There are severa medica waste treatment technoogies, namey, mechanica, therma, chemica, and irradiation processes[4,6,7. Mechanica process is used to change the physica form of the waste to faciitate waste handing. t consists of compaction and shredding. Compaction invoves compressing the waste into containers to reduce its voume. Shredding is used to break the waste into smaer piece. This process is not considered acceptabe for medica waste treatment by itsef. Therma process is designed to use heat at ow temperature «50 "C) and high temperature (600-5,500 "C) to decontaminate medica waste. The therma processes incude autocaving, mi-. 89. crowave treatment, and incineration. Autocave is a steam steriization technique that uses steam to contact with the waste directy to disinfect the waste. Microwave treatment is designed to use the eectromagnetic radiation spectrum ying between the frequencies 300 and 300,000 MHz to inactivate microbia organism. ncineration processes use high temperature (800 -, 050 "C) combustion under controed conditions to convert wastes containing infectious and pathogenic materia to inert materia residues and gases. t gives a significant voume and weight reduction and it steriize the waste. There is imitation of the incinerator due to the occurring poution during operation. t is needed to contro its temperature. Chemica process invoves the use of chemicas ike chorine compounds for disinfection. This system needs shredding step in order to provide sufficient contro between the waste and disinfectants. rradiation process is designed to use utravioet or ionizing radiation for irradiating and steriizing the medica waste.. Among these technoogies, autocave and incinerator methods are mosty used as a sequence for treatment and disposa of infectious waste..4 Laws and reguations for waste management n Thaiand, there are 4 maor Acts reated to hospita waste, namey, Pubic Heath, ndustry, Factory, and Nationa Enhanced and Preservation of Environmenta Quaity Act, 992[8. 2 Obectives Through this study, the assessment of existing WMPs and the quantification of medica waste generated in Chiang Mai hospitas were performed in order to propose the best WMPs of hospitas. 3 Materias and Methods The data were coected by surveying and interviewing the key informants who respond to waste management in hospitas and using a questionnaire which broady incuded information on the type, quantity of waste generated and existing disposa, incuding a WMPs. The categorization of the hospita waste was attempted according to the Ministry of Pubic Heath Notification for nfection Waste Managementm, 2002, and the reated reguations under the 4 maor Acts as mentioned above. The study was carried out in hospitas in Thaiand in 2004 as shown in Tabe. 4 Resuts and Discussion The waste management procedures and prac-
i i., Life Science ourna, 3 (2),2006, Panyaping, et a, Medica Waste Management Practices in Thaiand Ị tices in hospita are shown in Tabe 2. The sources of hospita waste come from patients and reated e- quipment and aboratory, various wards, X-ray and pharmaceutica room, buiding, housing and. The existing of WMPs in hospita showed that most hospitas have simiar probems associated with the procedure of medica waste management. There is handing (incuding initia handing, storage, and transportation) probem that needs to be improved in order to decrease the potentia of occupationa risks. For exampe, the transportation of, infectious waste in hospita shoud use eevator that deivers ony product materias. The 'container that provides for genera waste and infectious waste shoud have enough number of contaier in order to separate infectious waste from soid waste at source. f the infectious waste is contaminated with hazardous waste, it shoud be considered as hazardous waste and shoud be infectious waste. n the case of infectious waste and hazardous waste, it shoud have secondary containment to protect any eak of waste from packaging during their coection, storage, and transportation. Tabe. The sampe of hospita in Chiang Mai, Thaiand Size & Type Number of unit Number of bed. Big, G,400 2, Medium, G 53 3. Medium, P 400 4. Medium, P 350 5. Sma, P 80 Note: G = Government,P = Private n some medium hospitas, there are recycing program that generate income {or the hospita. This program shoud be expanded to other hospitas. n the process of storage,,a hospitas have the coor code and abe system to identify the waste container. For exampe, back container is used for genera or soid waste, yeow container is used for bottes and fuorescent amps, and red container is used for infectious waste. The containers are made from pastic. n a hospitas, the treatment and disposa of medica waste, particuary, the infectious waste is a very critica step in the process of waste management. Most of this probem comes from the treatment technoogy. Presenty, incinerator is the ony accepted treatment option to treat infectious waste such as organic matter, tissue or amputated human body parts. A imitation of the incinerator is that air poution probem during operation coud not be controed effectivey. Moreover, the ash from incinerator has never been anayzed. n some hospitas, the ash is buried in the hospita grounds. Furthermore, the operation and maintenance cost of incinerator is very high. Thus, the medium and sma hospitas prefer to send their infectious waste for treatment in private incinerators or big hospita incinerators. The treatment and disposa of hazardous wastes is aso another probem of hospita waste due to the quantity of hazardous waste that needs not ony specia handing and storage but aso specific treatment and disposa. n this case, the manua or standard operating procedure (SOP) shoud provide the important information for handing, storage, transportation, treatment and disposa of hazardous waste. n severa hospitas, some iquid chemica waste can be recyced but others are discharged to the WWTP. Athough a hospitas have their own WWTP (Tabe 3), some of them were experiencing probems with their WWTP due to the ack of experienced operators for maintenance and operation of the wastewater treatment system. Therefore, probems of wastewater quaity were found during monitoring. The quantity of medica waste generated in kiograms per day from different hospitas is shown in Tabe 4. t is found that the tota quantity of waste generated from a medium and sma hospitas was ower than the waste generated from big hospitas. Perhaps it is due to the big hospitas being equipped with modern faciities, and peope prefer this kind of hospita for heath care and treatment. t is noted that the soid waste or genera waste in big (3,000 kg/day) and medium hospita «830 kg/day) was higher than that in sma hospita «300 kg/day). The amount of hazardous waste in medium and big hospitas was in the same range (about 5 kg/day), but the quantity of this waste in sma hospita is not avaiabe. n some hospitas, iquid hazardous waste was aso generated. On comparison of unit (kg/daybed) contribution of infectious waste, it is found that the big government university hospitas contribute the most. However, the quantity of medica waste can significanty be reduced if the hospita avoided the use of disposabe medica care materias., A Ị. A i ) 4 ]. ; -.. 90. ], ;,
" Life Science]aurna, 3 (2),2006, Panyaping, et a, Medica Waste Management Practicesin Thaiand "" " Procedure. 8oid Waste () - 8ource - Segregation - Storage - Transportation - Treatment & Disposa. Hazardous Waste(HW) Big, Government - Buidings, W - Back bag & Big bin - n (carriage - Municipa Landfi Tabe 2. Medium, Government - Buidings, W - Back bag & Big bin - n (carriage - Recyce & Disrasa in Municipaandfi Procedure of WMPs in hospitas Size & Type of Hospita Medium, Private -Buidings, W - Back bag - n (carriage - Municipa Landfi Medium, Private - Buidings, - At source& W - Back bag - n (carriage - Municipa Landfi Sma, Private -Buidings, - At SOurce& W - Back bag - n (carriage - Municipa Landfi - 8ource & pharmaceutica & pharmaceutica & pharmaceutica & pharmaceutica & pharmaceutica "' - - - Segregation - Storage - Transportation - Treatment & Disposa. nfectious Waste (W) - 8ource - Segregation - Storage - Transportation Treatment & Disposa - Chemica Botte, Battery, fuorescent amp - Yeow - n (carriage - Private company reated equipment & ab. - n (carriage Autocave, Municipa andfi - Chemica Botte, Battery, fuorescent amp - dentified container - n (carriage - Storage for disposa reated equipment & ab. - n (carriage - Autocave, Municipa andfi - Chemica Botte, Battery, fuorescent amp - dentified - n (carriage - Storage for disposa reated equipment & ab. separate from - n (carriage - Autocave, Municipa andfi - Chemica Botte, Battery, fuorescent amp - dentified container - n (carriage - Private company reated equipment & ab. separate from - n (carriage - Autocave, Municipa andfi - Chemica Botte, Battery, fuorescent amp - - n (carriage - Municipa' andfi reated equipment & ab. separate from - n (carriage - Autocave, Municipa andfi r.,. 9.
i Size & Type. Big, G 2. Medium, G 3. Medium, P 4. Medium, P 5. Sma, P Note: Life Science ourna, 3 (2),2006, Panyaping, et a, Medica Waste Management Practices in Thaiand Tabe 3. Type of WWTP Activated Sudge Activated Sudge & Oxidation Ditch Activated Sudge Aerated Lag=n Size & Type. Big, Government 2. Medium, Government 5 Concusions 3. Medium, Private 4. Medium, Private 5. Sma, Private not avaiabe Activated Sudge Activated Sudge Tabe4. The WMPs in hospitas are drawn from the investigation as foow: ) A hospitas sent genera waste or soid waste to the municipa andfi. 2) The handing of medica waste shoud be propery impemented within hospitas and sent off site for disposa. 3) An adequate infrastructure for coection and transportation of the waste within and from each hospita to treatment faciities shoud be provided. 4) A poution prevention pan shoud be prepared and hospita staff shoud be trained on the pan's impementation. 5) The incinerator shoud be improved and inspected t-o reduce the impact on air quaity probem. 6) WWTP shoud be inspected reguary and be required to sove occurring probems. 7) A manua for handing hazardous waste shoud be prepared to cope with this waste in hospitas. The sma quantity of hazardous waste shoud be accumuated unti sufficient quantity is stored for Wastewater treatment pant in hospitas Main probem WWTP maintenance and operation No expertise operator & WWTP maintenance and operation Same Same Same Quantity of medica waste generated in hospitas Type of waste Quantity generated (kg day) nfectious waste 0.97 kg/daybed (352.08) Soid waste 3, 000 Hazardouswaste 4-5 nfectious waste 0.53 kg/daybed (279) Soid waste 830 Hazardous waste 3-5 nfectious waste 0.7 kg/daybed (00) Soid waste 300 Hazardouswaste nfectious waste Soid waste Hazardous waste 6.7 day (iquid chemica waste) nfectiouswaste 0.7 kg/daybed (29.89) Soid waste Hazardous waste. 92. transportation to the treatment and disposa faciity that is ocated in the centra part of Thaiand, a ong distance away, to avoid high cost of disposa. 8) The quantity of infectious waste in big hospitas is a higher rate (0.97 kg/daybed) than that in medium hospita (0.7 - O. 53 kg/daybed) and sma hospita (0.7 kg/daybed). 9) The standard operating procedure (SOP) that contains the outine of handing method, how coection, segregation, treatment and disposa as we as the reguation for segregation of infectious waste from hazardous waste shoud be ceary deveoped and operated. 0) Assigned agency shoud visit and inspect hospita's treatment faciities such as incinerators and wastewater treatment pants in order to improve the efficiency of these faciities and to sove probem when they occur. ) Moreover, a website to promote efficient dissemination of information and to improve existing medica WMPs as we as to reduce environmenta poution and heath hazards in the region shoud be done. n concusion, based upon the resut of this study, it is recommended that the procedure of the 4., of İ k. r. i,
- L. f Life Science ournat, 3 (2),2006, Panyaping, et a,medica Waste Management Practices in Thaiand best WMPs in hospita shoud be provided as the SOP for impementation by the hospita staff. Moreover, tht; aws and reguations reated to segregation of infectious waste from hazardous waste shoud be urgenty imposed. Acknowegments This paper is a part of the study proect on deveopment of hazardous waste business in the northern part of Thaiand. The authors woud ike to thank RMUTL, Chiang Mai and Fubright Thaiand-US Educationa Foundation for the cooperation in this proect. Thanks aso go to the staff of government and private hospitas for their geerous provision of information and fruitfu discussions throughout this study. Correspondence to: Kinpratoom Panyaping, Ph. D.. Department of Environmenta Engineering Raamagaa University of Technoogy Lanna (RM- TUL) Northern Campus, Chiang Mai 50300, Thaiand Emai: kin4@hotmai.com ; kinpratoomp@yahoo. com References. Word Heath Organization. Managing Medica Wastes in Deveoping Countries. 994. 2. Ministry of Pubic heath. Notification for nfectious Waste Management. Avaiabe from http: / /www. anamaio moph. go. th/[2004 September ] 2002. 3. Poution Contro Department, Ministry of Science, Technoogy and Environment. State of Thai Environment in 999. Thaiand. 2000. 4. George T chobanogous, Hiary Theisen, Samue Vigi. ntegrated Soid Waste Management Engineering Principes and Management ssues. McGraw-Hi, nc. USA. 993;978. 5. USEPA. Office of Soid Waste/Communications, nformation, and Resources. Management Division. RCRA Orientation Manua. Section,, and V. 998. 6. Michae D. LaGrega,Phiip L Buckingham,eHrey C E- vans. Hazardous Waste Management. McGraw-Hi Companies, nc. USA. 200; 202. 7. Reinhardt PA and Gordon G. nfectious and Medica Waste Management. Lewis Pubishers, USA. 99; 280. 8. Poution Contro Department, Ministry of Science, Technoogy and Environment. Laws and Standards on Poution Contro in Thaiand, 4th 00., 2000; 285. Received February 4, 2006 4. 93.